Wednesday, 28 February 2018

Research by Thomas Jefferson University in Philadelphia suggests giving women more intravenous, or IV, fluids during labor can significantly reduce c-section rates.

A new study from Thomas Jefferson University in Philadelphia shows women who receive more IV fluids during labor are at a lower risk of having a cesarean section and have shorter labors.

The study also revealed IV fluids shortened the overall length of labor by one hour and shortened the pushing phase of labor.

"The results are compelling and strongly argue for a change in practice," Dr. Vincenzo Berghella, director of Maternal Fetal Medicine and a professor in the Department of Obstetrics and Gynecology at the Sidney Kimmel Medical College at Thomas Jefferson University, said in a press release. "We have already begun changing practice at Jefferson to give women more fluids in labor, to allow them to have the best chance of delivering vaginally."

Researchers evaluated data from seven small clinical trials that involved a total of 1,215 women. About half of the women received IV fluids during labor at a rate of 250 milliliters an hour and half received IV fluids at 125 milliliters per hour. The common practice among doctors is to give the lower dose, 125 milliliters per hour, during labor.

"We've known that it's important for women to stay well hydrated during pregnancy and labor," Berghella said. "This study suggests that IV fluids could help women maintain hydration at appropriate levels, reduce the likelihood of c-section, and decrease length of labor. Recently, we also showed that letting women eat more liberally in labor, especially in early labor, has benefits including shorter labor, and no identifiable risks."ALSO READ: Balanced fluids, rather than saline, recommended for IVs...

In the past, women had been discouraged from eating or drinking during labor in case they had to be sedated for an emergency c-section.

Researchers at Vanderbilt University have a recommendation to medical providers: Don't use saline in intravenous bags.

Vanderbilt researchers found that patients are better off if given balanced fluids that closely resemble the liquid part of blood, rather than saline. The findings are based on companion landmark studies published Tuesday in the New England Journal of Medicine.

Vanderbilt researchers found that patients are better off if given balanced fluids that closely resemble the liquid part of blood instead of conventional saline

Dr. Matthew W. Semler of Vanderbilt University Medical Center in Nashville also presented the findings this week at the Society of Critical Care Medicine annual meeting.

"Our results suggest that using primarily balanced fluids should prevent death or severe kidney dysfunction for hundreds of Vanderbilt patients and tens of thousands of patients across the country each year," Semler said in a press release.

"Because balanced fluids and saline are similar in cost, the finding of better patient outcomes with balanced fluids in two large trials has prompted a change in practice at Vanderbilt toward using primarily balanced fluids for intravenous fluid therapy."

The researchers examined 15,802 intensive care patients in one trial and 13,347 emergency department patients in another trial. They were assigned to receive saline or balanced fluids if they required intravenous fluid between June 2015 and April 2017.

Serious kidney problems or death occurred 1 percent less often in the balanced fluids group compared with the saline group, according to the studies.

"The difference, while small for individual patients, is significant on a population level," said study author Dr. Wesley Self, an associate professor of Emergency Medicine. "When we say a 1 percent reduction, that means thousands and thousands of patients would be better off."

Switching from saline to balanced fluids could lead to more than 100,000 fewer patients experiencing kidney damage or dying every year in the United States, the researchers estimate.

In the surgery study, 14.3 percent of the patients treated with a balanced crystalloid solution experienced a major adverse kidney event compared with 15.4 percent of patients given saline intravenous fluids. In-hospital deaths at 30 days was 10.3 percent in the balanced-crystalloids group and 11.1 percent in the saline group

In a second trial, the number of hospital-free days was similar between the two groups. But use of balanced crystalloids resulted in a lower incidence of major adverse kidney events within 30 days -- 4.7 percent, compared to 5.6 percent in the saline group.

"Doctors have been giving patients IV fluids for more than 100 years and saline has been the most common fluid patients have been getting," said study author Dr. Todd Rice, an associate professor of Medicine.

"With the number of patients treated at Vanderbilt every year, the use of balanced fluids in patients could result in hundreds or even thousands of fewer patients in our community dying or developing kidney failure," they said. "After these results became available, medical care at Vanderbilt changed so that doctors now preferentially use balanced fluids."

"After roughly 75 years of intravenous medicine and 50 years of advanced trauma life support, we are finally recognizing that maybe what we should be giving is what the patient has been losing," Buchman said.

A simple urine test apparently can reveal how old your body really is -- showing its biological, not chronological age.

That information can then help determine your risk for age-related diseases and even death, a new study suggests.

The test checks for a substance -- called a marker -- that indicates cellular damage from a process known as oxidation. The substance increases in urine as people get older.

"As we age, we suffer increasing oxidative damage, and so the levels of oxidative markers increase in our body," explained study co-author Jian-Ping Cai, a researcher at the National Center of Gerontology at Beijing Hospital in China.

People's bodies age at different rates, according to the researchers. That's due to varying amounts of cellular damage associated with such factors as genetics, lifestyle and environment.

For their study, the researchers focused on an oxidation marker called 8-oxo-7,8-dihydroguanosine (8-oxoGsn). They measured levels of this marker in urine samples from more than 1,200 people in China, ages 2 to 90, and found age-related increases in the marker among those 21 and older.

A failed drug compound tested on people with osteoarthritis pain might prevent opioid tolerance and physical dependence when used with opioid-based pain medications, according to a study.

A drug compound might prevent opioid tolerance and physical dependence when used with opioid-based pain medications, according to a study.

Researchers at Indiana University found the compound appears to block neuropathic pain and decrease signs of opioid dependence, according to findings published in the February issue of the journal Molecular Pharmacology.

Eli Lilly's trials of the drug for osteoarthritis pain were unsuccessful. At the time, the drug's use in treating other kinds of pain and lessening opioid dependence wasn't tested. But researchers opted to start testing it after they found it interacted with the body on a target known to be involved with pain relief.

The need for more effective painkillers that carry fewer dangers of misuse and abuse than opioids is great. The Centers for Disease Control and Prevention report that, in 2016, more than 11 million people abused prescription drugs, including opioids, and more 64,000 Americans died from drug overdoses.

"The potential to quickly begin using this compound in combination with opioid-based medication to treat pain and reduce addiction makes this discovery very significant," lead investigator Andrea G. Hohmann, a professor in the IU Bloomington College of Arts and Sciences' Department of Psychological and Brain Sciences, said in a press release. "We already know this drug is safe for use in people, so moving into human trials will not require as many regulatory hurdles."

To test its effects and potential for addiction, Indiana University scientists administered the compound, called LY2828360, and the opioid drug morphine to male mice with neuropathic pain.

When a low dose of the experimental drug was combined with morphine, however, the mice no longer became tolerant to morphine -- even after the experimental drug was discontinued. The researchers also found the compound reduced pain on its own at higher doses.ALSO READ: How a tumor grows can tell which drug to use...

Mice also were given morphine alone or morphine in combination with the experimental drug, and then treated with naloxone. Naloxone is regularly used to block the effect of opioids and induces opioid withdrawal symptoms. In the experiment, the experimental drug also decreased the severity of withdrawal symptoms.

Saturday, 23 December 2017

Who hasn’t been in a relationship we know is bad for us, but one we just can’t quit? For many people, it’s like that with sugar.

Breaking up is hard to do.

“People generally know that sugar isn’t good, but they don’t appreciate how powerfully negative it really is,” says Donald Hensrud, medical director of the Mayo Clinic Healthy Living Program. “If you look at all the things in our diet we can change, pulling away from refined or added sugar will do more good than anything else.”

Eating too much sugar contributes to numerous health problems, including weight gain, Type 2 diabetes, cavities, metabolic syndrome and heart disease, and even indirectly to cancer because of obesity. It also can keep you from consuming healthier things. “Kids who are drinking sugar-sweetened beverages aren’t drinking milk,” Hensrud says.Also Read...How a tumor grows can tell which drug to use Somesexualtransmitteddiseases (STD/STI)

Between 2003 and 2010, Americans consumed about 14 percent of their total daily calories from added sugars, much of it from sugar-sweetened beverages, according to the Centers for Disease Control and Prevention. But the 2015-2020 Dietary Guidelines for Americans recommend an intake of added sugar of less than 10 percent of calories. In a 2,000-calorie daily diet, that means less than 200 calories. Ten percent would amount to about 50 grams of sugar, according to Hensrud, who points out that food labels list sugar-per-serving in grams, making it easy to calculate. (With four grams to a teaspoon, that’s about 12 teaspoons.)

While the World Health Organization also recommends a 10 percent limit, it stresses that 5 percent would be even better. That amounts to less than one serving (about eight ounces) of a typical sugary drink, according to WHO. “The lower the number, the better,” Hensrud says.

Over the past 30 years, American adults’ consumption of sugar increased by more than 30 percent, from 228 calories a day to 300, according to a study released last year. “This is equivalent to eating an additional 15 pounds of sugar a year,” Hensrud says.

For many years, saturated and trans fats were regarded as the big dietary villains. While some fats are unhealthy, experts now believe it is wiser to focus on cutting back sugar than on paring fats.

“Quality sources of red meat, like grass-fed bison, beef and yak, are a great source of minerals, [conjugated linoleic acid] and protein, which will provide health benefits to our bodies,” says Jessica Murgueytio, a clinical dietitian in Bethesda, Maryland. Most people do better limiting saturated fat — red meat has high levels of saturated fat — than they do sugar, “primarily because saturated fats don’t have the same addictive quality” as sugar, she adds.

Indeed, when people say they have a sweet tooth, they really are suffering from a “sweet brain” — because that’s where sugar rules. Sugar resembles other abused substances in that “it is reinforcing and can change how you feel,” says former Food and Drug Administration Commissioner David Kessler, whose 2009 book “The End of Overeating” describes the science behind Americans’ obsession with sugar. “It’s rewarding. And it’s self-administered.”

Past memory of eating sweet things produces cues that induce the craving for more, he adds. “I had that chocolate chip cookie in the past, and it changed how I feel. I had the momentary bliss from the consumption of sweetness, and that makes me want more,” he says. “Sugar is an effective agent that produces excess calories and stimulates further eating. That’s why the old saying ‘A calorie is a calorie’ is a fallacy.” The source of that calorie matters, he says.

Animal studies have shown that sugar releases opioids and dopamine in the brain, which suggests that sugar dependence is real. “Consuming large amounts of added sugar activates the reward center and makes us want to eat that food again,” Murgueytio says. When this happens, “you can have increased cravings for sugar, feel a lack of control when around sugar, and also increased tolerance for sugar, which causes one to eat more to feel the same impact.”

Artificial sweeteners don’t help because they can have the same effect. “Artificial sweeteners in small amounts, like one pack in your coffee or tea, are safe and not harmful, but having large amounts, like in diet sodas and sugar-free candies daily, can make sweet cravings a lot worse,” Murgueytio says.

Recent research suggests that a high intake of artificially sweetened products can result in increases in body fat, waist circumference and body mass index.

This is, of course, the best of times and the worst of times to end it with sugar — the best because most people have their biggest weight gain between Thanksgiving and New Year’s (and often can't get rid of it) and the worst because there are so many holiday temptations.

Save the sweets for special days, like Christmas morning and New Year’s Eve, and avoid them when they matter less, like at 3 p.m. in the office. At parties, don’t stand by the buffet table. Freeze your leftover desserts, or send them home with family or friends. Try to stay out of grocery store food aisles that feature sugary holiday treats, and avoid gourmet and specialty shops whose shelves seem to be overloaded with them this time of year.

As for the remainder of the year, read the labels on your unopened processed foods. If they have high levels of added sugar per serving, several grams, for example, return them. Use the store credit to buy fresh fruit.

If you drink fruit juice, dilute it with unflavored club soda or seltzer. Gradually reduce the amount of sugar you put in your coffee and tea. You’ll get used to it. Make your own salad dressing. If you think you can stop with just one small piece of chocolate, great. But stick to the dark variety, which has less sugar than milk chocolate (and has some health benefits of its own).

Restaurant eating can be tough. Put olive oil and vinegar on your salad, and have grilled chicken or fish — no sauces. Skip the mixed drinks and cocktails and switch to a dry wine. Avoid baked goodies, and have fresh fruit for dessert.

You can live without sweetness, Kessler says. “If you moved to a continent where there was no sweetness, you would adapt,” he says. “After a while, if you couldn’t have access, you would stop wanting.”

But if you must, retrain your palate to appreciate the sweetness of foods in their natural state. Fresh fruit has sugar, but it also has water, fiber and other nutrients. The average candy bar has 270 calories. A small piece of fruit has about 60. You can eat an apple, an orange, a pear and a peach and get fewer calories than in that one candy bar.

You can end that toxic relationship. “Sugar does have a powerful hold on us, but there are ways to separate gently,” Hensrud says. “If you can’t totally break up with sugar, consider finding a new partner — in fruit.”

New research out of the University of Southern California suggests the growth patterns specific to a tumor can predict which cancer therapies are likely to work best.

Like the patients in which they grow, every tumor is unique. Doctors and researchers are becoming increasingly aware of this fact as they devise individualized cancer treatments. Because each tumor is unique, cancerous growths respond differently to various drugs.
Cancer drugs can have deleterious side effects, so finding the most effective drug -- or combination of drugs -- on the first try is imperative.

"Identifying a measurement or quantity that predicts how specific tumors will respond, called a predictive biomarker, is extremely valuable to cancer research," Stacey Finley, a assistant professor of biomedical engineering at USC, said in a news release.

Tumors need nutrients to fuel their growth. To get what they need, the cancer growth hijacks a process known as angiogenesis, which generates new blood vessels from the existing vasculature. Previous studies have shown tumor growth can be slowed by blocking or curbing vascular endothelial growth factor, or VEGF, a protein that promotes angiogenesis.

To better understand why some tumors reposed better to VEGF-blocking treatments than others, researchers built a computational model of tumor-bearing mice. They used the model, which was designed using real experimental and clinical data, to identify relationships between the drug's efficacy and certain properties of tumor growth.

"We found that certain parameters about the way the tumor grows could successfully and accurately predict the response to anti-angiogenic treatment that inhibits VEGF signaling in the mouse," Finley said. "Using the characteristics of the tumor's growth, we can predict how effective the anti-angiogenic therapy will be, or whether the tumor's growth will slow down, even before treatment begins."

Scientists published the results of their modeling work in the journal PLOS Computational Biology.

The next step is to reverse engineer the model and use it to analyze mice tumors in order to predict the efficacy of VEGF-inhibtor drugs.